Sunday, October 17, 2010

Importance of Learning the Truth

Being in Medical school I have, obviously, learned how to take a history and physical (to a certain extent). The teachers always emphasize that 80% or more of the cases we will see can be solved just with a good history and physical. However, in the introduction to our Cardiovascular system class we had a great teacher that explained something that seems so simple, "You see only what you look for and you recognize only what you know." Obvious? I thought so, but then I realized the significance of this statement after I read a section in Discover Magazine (Vital Signs by H. Lee Kagan). The story goes like this:

"The Student emerged from the examination room, chart in hand, and planted himself next to me in the hallway where I was finishing up my notes on another patient. Anxious to share his discovery, he leaned over and whispered, 'I think she has a mass in her pelvis (hip area).'.......I knew the student had asked the patient a battery of questions, but how good was he at taking the next step-- making the connections between her answers and his physical findings (E-Man: Basically, the doctor is wondering if the student can figure out what is causing the pelvic mass). I asked him if she had any symptoms related to the mass. 'Related to the mass?' he echoed as I watched him struggle to come up with something......'You told me that she had no complaint of pain....[Was there] Dyspareunia?' His brow furrowed and his eyes nearly crossed. I realized he didn't know what the word meant.....'Dyspareunia,' I told him, 'pain with intercourse. It can accompany a number of conditions, including pelvic tumors.' He stared at me, bewildered. I stared back at him, 'What?' He glanced away and then whispered, 'I thought intercourse was supposed to hurt the woman.' He was dead serious...When we had chatted earlier, he told me he had been raised outside of the United States, in a country that I knew had less progressive views of women's rights. Had he brought this bit of nonsense with him from the old country?"

This story details a serious problem with misinformation, it can be deadly. If this student had never learned that intercourse is not supposed to be painful for the woman then he could have missed many diagnosis of ovarian cancer which, as the author points out later, sometimes only shows up as pain with intercourse. That is a very scary thought, someone's cultural influence with misinformation could lead to life endangerment.

I think this story, along with countless others, can reveal the need for people to teach young people the truth. The culture which this young medical student came from could have cost a number of women their lives.

This is not only true about science and medicine, but I think it is true of Judaism as well. There is a lot of misinformation that is found out there with regard to Judaism that is spread by Jews and people who hate Judaism. For instance, this incident  that the Wolf talks about is mind boggling. This idea could ruin a persons future marriage or love life with their spouse. Also, when the child discovers that he or she was lied to that could turn them off from the religion entirely. This is true with regard to how some people discuss Chazal's infallibility and scientific knowledge found in the Gemorah as well. When someone lies, states something that is easily falsifiable, to their children or students, that is the most dangerous thing. In fact, it turns so many people off and ends up "killing" many student's or childrens' desires to learn more about the religion, they just give it up because it is "full of false beliefs."

There are appropriate ways to teach children about difficult subjects and there are bad ways to teach children about difficult subjects. If you are incapable of discussing it with them, you shouldn't lie about it. Please, find someone who can discuss this subject with them, they will thank you for your ability to realize when you do not understand how to deal with something and G-D will thank you for your intelligent decision to explain these difficult situations appropriately and meaningfully, aka by using someone more knowledgeable about the subject. 


Mordechai Y. Scher said...

Vital Signs was a long-time favorite column in our house.

About H and Ps. Patients can change them several times. That's why it pays to confirm information, and have others repeat questions during the course of care.

Maaseh she'haya - my wife was a resident in a local hospital. She comes home and says 'I got that patient you brought in with the xyz.' (I was doing Sundays as a paramedic while teaching in Boston.) 'I didn't bring in any patient with xyz.' 'Sure you did. Your run report was in the chart. I recognized your signature.' When I checked, I had gotten one Hx from the patient; the ER staff got different info; and my wife, after the patient was admitted, got yet more/different info. Some patients are terrible historians, so be prepared!

E-Man said...

Thanks for the heads up!

Garnel Ironheart said...

1) Early dementia is often unrecognized in the elderly and leads to the changing of histories. I once took a student to the ER with me. She went off and took a very thorough history on an 85 year old man who had been brought in by ambulance with "chest discomfort". After listening to her presentation, I went and did my own history to confirm. Not ONE detail was the same, much to my student's horror. I reassured her that this is why confirming details with the patient and anyone else around who knows him is so important.
2) Use the nurse's notes as a guide but not gospel. I've had lots of patients who tell the nurse one thing and then tell me "the truth" and explain that they changed their story because "Well, she's just the nurse, she doesn't need to know."
But for your MAIN point:
Medicine is complex. Judaism is even more complex. In medicine, you can embrace the complexity and spend your lifetime exploring the incredible world it presents, never ending your learning, never ceasing to challenge your assumptions, never growing medically. Or you can become a walk-in clinic doctor and spend the rest of the your life giving amoxycillin to everyone with a cold and naproxen to everyone with a sore back.
Same thing with Torah. You can dive into the complexity, understand that there are no simple answers to complex questions, that diversity of opinion is part of the halachic process and so on. Or you can say "I'll always be machmir and even invent machmir rules just to be safe". Too many people take the walk-in clinic approach to Judaism and pretend they're subspecialized internists.
You know, I just might do a post on that...

E-Man said...

I hope you do, and I will read it, BN.

Mordechai Y. Scher said...

Nicely put, Dr. Garnel...

Garnel Ironheart said...

Thank you Dr. Mordechai.

Now, E-man, you might be interested in this program:

E-Man said...

Thanks Garnel, I actually had a friend that went on this program and said it was amazing. I hope I can go one summer.